Dental care and the elderly


Brush your teeth, floss and see the dentist. Protecting your teeth and gums is a relatively simple process, until it’s not.

Life can get in the way of self-care. Seniors, for example, can face serious dental hygiene challenges. This is especially true for someone who is disabled or has a chronic illness like Alzheimer’s disease. It is therefore essential that you, as the caregiver, do everything you can to ensure that your older loved one maintains their oral health. Improper dental hygiene has been linked to heart disease, stroke and osteoporosis and, on a more fundamental level, can affect your loved one’s ability to eat or speak.

According to the American Dental Association (ADA), general concerns for adults over 60 include a second set of years prone to cavities, largely due to medications that can cause dry mouth, as well as an increased risk of gum disease and oral cancer.

Dental patients with certain heart conditions may also be at risk for bacteremia, which means bacteria can enter the bloodstream after a dental procedure. And when someone is confined to bed, bacteria from poor mouth care can be inhaled into the lungs and cause pneumonia. People with dementia face their own unique dental care challenges, as they may forget how to brush and floss, or why it is important, and may have difficulty performing these actions by themselves. The good news is that vigilant caregivers can do a lot to combat each of these issues.

It’s important to take your loved one to the dentist for regular checkups and to prevent or fix these potential problems:

  • Dry mouth. A side effect of over 500 medications, dry mouth is a common cause of cavities in the elderly and can also lead to ulcers and sores. These drugs include many drugs for high blood pressure, high cholesterol, pain, anxiety, depression, Alzheimer’s and Parkinson’s disease. If your loved one has symptoms of dry mouth, a dentist may use a gel or varnish to help prevent cavities or recommend an oral moisturizing spray or over-the-counter mouthwash. You can also help your loved one by making sure they drink more water and avoid foods and beverages like coffee, alcohol, fruit juices, and carbonated drinks, as they can irritate dry mouth. You may also consider talking with your loved one’s doctor about changing medication doses.
  • Mouth cancer. Regular visits to the dentist are important so that your loved one can get tested for oral cancer. The average age of most people diagnosed with these cancers is 62 years old. Early detection can save lives since oral cancer usually does not cause pain in its early stages.
  • periodontal disease. As with oral cancer, periodontal disease usually does not cause pain until it has progressed. At this stage, it can destroy gums, bones and ligaments and lead to tooth loss. This disease is caused by bacteria present in dental plaque, which can irritate the gums. It can be treated or prevented completely with regular dental or periodontal appointments.
  • Abscessed or broken teeth. An abscess is a painful infection inside the tooth that can quickly spread to the gums. If broken teeth are ignored, they can cause serious infections in the mouth.
  • Antibiotic prophylaxis. For a small number of people with specific heart conditions, antibiotics are recommended before certain dental procedures. This is called “antibiotic prophylaxis”. The problem is that bacteria from the mouth can enter the bloodstream, causing infection in other parts of the body. For specific ADA guidelines, go to

Maintaining proper dental care can be a lot trickier, of course, if your loved one has dementia. A person with intermediate and advanced Alzheimer’s disease may not remember how to use toothpaste or rinse and may resist being helped to do so. However, there are a number of things you can do to make your loved one’s experience easier. A home health aide could also be of great assistance to you, if you feel that you cannot go it alone. They are trained to meet the needs of people with specific pathologies such as dementia, or disabled and/or bedridden people. A home helper or medical professional can offer soothing advice and carefully maneuver your loved one to prevent injury.

The following dental care tips may help if your loved one has dementia:

  • Pick the right place and the right time. If the bathroom is difficult for both of you to navigate, sit your loved one in a comfortable chair and try using the kitchen sink or a basin on a table. It might also be best for you to sit or stand behind your loved one while you go through the teeth cleaning routine. If your loved one is resistant, don’t force their mouth open. You may need to wait for a quieter time if he is restless, but make sure the last brushing follows dinner or any liquid medication taken in the evening.
  • Break down and demonstrate the steps. If your loved one is able to understand simple instructions, break the actions down into small steps by saying, “Hold your toothbrush”, and “put the toothpaste on the brush”, etc. If he needs more help, put the paste on the brush and model the brushing motion up and down or put your hand over his and gently guide the motion. Take care to clean the teeth, gums, tongue and roof of the mouth twice a day. A children’s toothbrush with soft bristles is best, and a long-handled or angled brush may be easier for your love to handle. You could even try putting the handle through a tennis ball for something bigger to hold. Rinsing with an antimicrobial mouthwash can also be helpful, but be careful that your loved one does not swallow it.
  • Don’t forget to use dental floss. Flossing daily is important. Do it gently, using a dental flosser, but if that’s too much for your loved one, a Proxabrush handle and brush system can also help clean between the teeth.
  • Watch for signs of mouth pain or bad breath. If your loved one doesn’t eat at mealtimes or seems tense while eating, it could be a sign of a dental problem. Other signs include rubbing or touching the cheek or jaw, screaming or moaning, and flinching, especially when washing the face or shaving. Be sure to take your loved one to the dentist if any of these things happen. Causes of bad breath include dry mouth, medications, and certain foods, but it can also signal an infection.
  • Dental care. If your loved one wears dentures, rinse them with clean water after meals and brush them daily. Take them out every night and soak them in cleanser or mouthwash. While they’re out, try brushing your loved one’s gums, tongue, and roof of their mouth with a soft-bristled toothbrush or gauze. Ask the dentist to regularly check dentures.

Your local dental society can provide you with the names of dentists experienced in working with people with dementia or disabilities. For more information, see the Special Care Dentistry Association Reference Directory. The Weill Institute for Neurosciences Memory and Aging Center at the University of California, San Francisco also offers a useful tool. dental hygiene aid video.


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